There was general agreement that we need to support local authorities through these unprecedented changes. There are concerns that although many councils want to do a good job, some feel they don't know how.

There was a desire for a shared definition of health inequalities so that we can hold each other accountable.

There is a risk of increasing health inequalities between local areas if there is no national accountability.

Local authorities cannot address all the issues. They need to know their priorities, and the NHS community needs to support them.

Although the ongoing changes are unprecedented, we need to accept that the old system is dead, to quote one person at the debate, and we now "need new radical ways to do business". The mood was that we need to move forward and embrace new allegiances and partnerships.

There was concern over the political implications these reforms will have on public health policy. The priorities of local politicians may be different to the needs of the community. The motivation of local politicians may be driven by electoral priorities, and they may therefore support schemes that yield quick rewards rather than long-term health gains. But it is the responsibility of public health officials to brief them and set the agenda.

The health sector should be liaising with local politicians and the local community to ensure the needs of the community are met. The concern is that people "who are of the lowest equity are the least likely to vote and those who vote are the least likely to care". Communities need strong advocacy and leadership to ensure there is a "channel between those in need and those who provide".

Everyone needs to see themselves as accountable, including all the leaders and chief executives of local authorities. The secretary of state has a statutory duty to reduce health inequalities – but how he will be held accountable? The Department of Health "should have as much power as influence", but it is not enough to just publish reports and evidence. Evidence-based medicine needs to be implemented and used in a powerful way.

In the second in a series of debates on public health reforms, Denis Campbell finds that those working in the sector share many concerns about the changes but also optimism that historic inequalities could be tackled